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Insurance denied me surgery, how do I appeal this? Insurance denied me surgery, how do I appeal this?

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Unread 02-05-2002, 05:30 PM
Insurance denied me surgery, how do I appeal this?

My doctor scheduled me for sugery on Feb. 11. He had 3 medical reasons for doing a
total hysterectomy, and said it would be no problem. I have had endometreosis, and several surgeries for it, I am on Tri levlen to try and control it. I bleed half the month and still have bad cramps. I only have one week out of the month where I feel well, the rest of the month I have pain, and hormone related migraines. I have missed a lot of work because of all this. The doctor at the insurance said I should try alternative methods to control my problems, ie. more drugs. I am on perscription meds for migraines, which doesn't always work any more, and the last time I was on higher levels of estrogen, I was nausiated all day long. How can I win this appeal? Cathy
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Unread 02-05-2002, 05:49 PM
Insurance denied me surgery, how do I appeal this?

Cathy, I wish I had a good answer for you, but unfortunately I don't. I must say I am surprised at this though. What kind of insurance do you have? I guess everything was coded correctly by your Doc's office? I am so sorry. I would definitely keep trying and I'm sure others will be along with some good ideas for you.


Unread 02-05-2002, 06:01 PM
Thanks Emma

I am working on an appeal, when I called the doctor's office they did not know it
was denied, but will call the insurance company tomorrow to see what else can be done. My insurance is a HMO, through the state of WI, so I don't know if that is the problem or not.
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Unread 02-05-2002, 06:41 PM
Insurance denied me surgery, how do I appeal this?

Cathy, I clicked on the search button for you and came up with these posts regarding insurance:

Maybe these will help you and give you some ideas! I hope so!

Take care and I'm glad you appealed. I'll be praying that things work out for you, Cathy!

Unread 02-05-2002, 07:18 PM

I was scheduled for an ablation in Sept. 2000. I have adenomyosis, polyps, fibroids, heavy bleeding (just like you). My insurance company denied me as well. I had my primary DR, my gyn Dr fighting everyone they could. Finally I left a message on the insurance company's machine that I was going to go to the local radio station and tell my story. It was an election year and people were talking about HMO's any way and I had a story to tell! Well I'm not sure if that actually worked or if it all did some good, but they turned around and reversed their decision and granted me the surgery. I'm scheduled to have a LAVH on the 26th of this month. I'm hoping they don't decide to mess with me again. If they do I still have a story to tell....
I'll be praying for you.

Unread 02-06-2002, 07:22 AM
Insurance denied me surgery, how do I appeal this?


Check the website. Not long ago they ran an article on how to appeal a denial of treatment. They also included info on what to do if the appeal is turned down. I believe the article included sample letters that would make the HMO sit up and pay attention. Check also with your own doctor to see if he will further advocate for you. The fact that you are missing a lot of work is a true cost and affects a lot of people. It sounds like you've given drugs a reasonable trial, and your doctor had agreed on that.

Good luck on your appeal, and let us know how it goes.
Unread 02-08-2002, 04:44 PM
thanks for the links and letters

My surgery was appoved this afternoon after my doctor called the insurance himself. Talk about cutting it close, my surgery is scheduled for Monday. Cathy
Unread 02-08-2002, 04:56 PM
Insurance denied me surgery, how do I appeal this?

Thank goodness!

I was on the cell phone to my ins. co. from the parking lot of the hospital, right after my pre-op - I know how you feel!

Now you can relax and have a little fun this weekend before you head off to the castle.
Unread 02-08-2002, 07:26 PM
Insurance denied me surgery, how do I appeal this?

Yayyyyyyy!!! I'm so glad your surgery was approved!! Now, you'll be in my prayers for an uneventful surgery and recovery. I'll be thinking about you on Monday!



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